Medicare Advantage and Medigap Plan G are two options for Medicare beneficiaries looking to supplement their Original Medicare coverage. With Medicare Advantage, you enroll in private health insurance plans approved by Medicare that provide all of your Part A and Part B benefits. Plan G is a Medigap policy sold by private insurance companies that helps pay for costs left over after Original Medicare pays its share. Understanding the key differences between these two plans can help you choose the right supplemental coverage.
Medicare Advantage, also known as Medicare Part C, allows you to receive your Medicare benefits through private insurers approved by Medicare. Medicare Advantage Plans may cover everything that traditional Medicare covers, but many offer additional benefits like vision, hearing, dental, and prescription drug coverage. Medicare Advantage Plans type of plan often have lower premiums than Original Medicare plus Medicare Supplement insurance or Medigap policy. However, provider networks and service areas are limited.
There are different types of Medicare Advantage Plans including:
HMO: Health Maintenance Organizations provide care from a network. Referrals are required for specialists.
PPO: Preferred Provider Organizations allow more flexibility to see out-of-network providers for a higher cost.
PFFS: Private Fee-For-Service plans allow you to see any Medicare provider as long as they accept the plan's payment terms.
SNP: Special Needs Plans are designed for specific populations like those with chronic illnesses.
Medigap Plan G is one of 10 standardized Medigap policies sold by private insurance companies to help fill coverage gaps in Original Medicare. Here's what Plan G covers:
Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Medicare Part B coinsurance or copayment
First 3 pints of blood per year
Part A hospice care coinsurance or copayment
Skilled nursing facility care coinsurance
Part A and B deductibles
Part B excess charges
Foreign travel emergency care (up to plan limits)
There are several key differences between Medicare Advantage and Medigap Plan G:
Coverage - Medicare Advantage Plans replace Original Medicare, while Plan G supplements it.
Costs - Medicare Advantage often has lower premiums, but can have copays and deductibles. Plan G has higher premiums.
Providers - Medicare Advantage has network restrictions while Plan G allows you to see any provider who accepts Medicare.
Prescription Drugs - Most Medicare Advantage Plans include Part D drug coverage. Plan G does not cover prescriptions.
Travel - Plan G provides foreign travel emergency care. Medicare Advantage only covers emergencies within the U.S.
Medicare Advantage Plans often have $0 premiums or low monthly premiums compared to Medigap policies. However, with Medicare Advantage you may still pay deductibles, copays or coinsurance depending on the plan. Plan G has higher premiums, but covers more out-of-pocket costs. Weigh the total costs when choosing coverage.
VI. Pros and Cons of Medicare Advantage and Plan G
Medicare Advantage Pros
Extra benefits like vision and dental
Part D drug coverage included
Medicare Advantage Cons
Referrals needed for specialists
Prior authorizations for services
Plan G Pros
Freedom to choose any Medicare provider
Low out-of-pocket costs
Plan G Cons
No drug coverage
Can't combine with Medicare Advantage
Those who may benefit most from a Medicare Advantage Plan include:
Those wanting lower premiums and don't mind networks
People with chronic conditions who qualify for Special Needs Plans
Those who travel within the U.S. only
Those who may benefit most from Plan G include:
People who want broad provider choice and network flexibility
Frequent travelers who want foreign travel emergency coverage
Those looking for comprehensive supplemental coverage
You can leave a Medicare Advantage Plan and switch back to Original Medicare during the Annual Enrollment Period from October 15 to December 7 each year. Your coverage will start on January 1 of the next year. You can also switch to Original Medicare from January 1 to February 14. Your coverage starts the first of the month after the plan gets your request.
When you switch back to Original Medicare, you'll be able to add a stand-alone Part D prescription drug plan and a Medigap policy - but you may need to pass underwriting if it's your first time purchasing a Medigap policy. Keep this in mind when evaluating your options.
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Bourgeois Insurance a Call at (985) 803-8999. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
Plan G is one of the most popular Medigap Plans. It covers Medicare Part A and B coinsurance and copays except the Part B deductible.
Advantage Plans replace Original Medicare, while Supplement Plans like Medigap Plan G fill coverage gaps left by Parts A and B.
The initial enrollment period is the 7 months surrounding your 65th birthday - you must enroll unless you have qualifying health coverage.
Main types are HMOs, PPOs, Private Fee-For-Service Plans and Special Needs Plans. Coverage and networks vary significantly between plan options.
Parts A and B cover items like hospital stays, doctors' visits, preventive care, and some medical equipment and supplies.
Consider your coverage needs, budget and providers. Seek advice from unbiased sources as every person's situation is unique.
Open Enrollment runs from October 15 - December 7 each year for coverage effective the following January 1.
Part D provides drug coverage that is acquired separately or bundled into a Medicare Advantage Plan. Stand-alone PDPs and MA-PDs offer this.
During the Open Enrollment Period each fall, you may join another MA plan for the following year.
Annual Notices of Change from existing plans and information packets from CMS help beneficiaries evaluate plan options.
Medicare.gov/plan-compare allows customized searches comparing coverage/costs of Medigap, Medicare Advantage and Part D Plans in your area.
Contact the specific Part D Plan directly to complete enrollment once you've selected a PDP to coordinate new coverage start dates.
311 N Canal Blvd Thibodaux, LA 70301
311 N Canal Blvd Thibodaux, LA 70301
Plans are insured or covered by Medicare Advantage (HMO, PPO, and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan in your area. Please contact medicare.gov or 1-800-Medicare to get information on all your options.
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